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Transnasal bamboo foreign body lodged in the sphenoid sinus
Auris Nasus Larynx 28 (2001) 365– 367 www.elsevier.com/locate/anl
Transnasal bamboo foreign body lodged in the sphenoid sinus Shin-ichiro Kitajiri *, Keisaku Tabuchi, Harukazu Hiraumi Department of Otolaryngology, Toyooka Hospital, 6 -35 Tachino-cho, Toyooka City, Hyogo 668 -8501, Japan Received 5 January 2001; received in revised form 3 March 2001; accepted 23 March 2001
Abstract Transnasal sphenoid sinus foreign body is a rare condition. We report a very rare case of transnasal bamboo foreign body lodged in the sphenoid sinus without damages to the orbital wall or skull base. A 69-year-old man fell down onto a bamboo stick, which snapped after penetrating his face through the right nostril. CT demonstrated that the bamboo stick stuck into the middle meatus, penetrated the ethmoid sinus just medial to the lamina papyracea and reached to the sphenoid sinus. No abnormal findings were detected in the orbit or skull base. The foreign body was removed from the nasal cavity without any complication. The endoscope was useful for evaluating possible injuries in the orbit and skull base and confirming the absence of residual foreign bodies. © 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Sphenoid sinus; Foreign body; Transnasal; Endoscope
1. Introduction Foreign bodies lodge in the ethmoid and sphenoid sinuses mostly through the medial canthus [1]. Transnasal sphenoid sinus foreign body is a rare condition with only 11 cases reported in the literature. In all these cases, intracranial injuries were associated. We report a very rare case of transnasal bamboo foreign body lodged in the sphenoid sinus without damages to the orbital wall or skull base.
and other cranial nerve symptoms were not noted. CT demonstrated that the bamboo stick, cylindrical structure containing air spaces, stuck into the middle meatus, penetrated the ethmoid sinus just medial to the lamina papyracea and reached to the sphenoid sinus. No abnormal findings were detected in the orbit or skull base (Figs. 1 and 2).
2. Case report While picking edible wild plants, a 69-year-old man fell down onto a bamboo stick, which snapped after penetrating his face through the right nostril. He was transferred to the Emergency Department of our hospital. Although nasal bleeding had stopped on his arrival, the bamboo stick with a diameter of about 1 cm was lodged in the middle meatus of the right nose. The outer tip of the stick was located posterior to the nasal vestibule. Visual disturbance, double vision, headache * Corresponding author. Tel.: + 81-796-226111; fax: + 81-796240596. E-mail address: [email protected] (S. Kitajiri).
Fig. 1. Coronal CT demonstrated that the bamboo stick (*, asterisk) stuck into the middle meatus, penetrated the ethmoid sinus, just medial to the lamina papyracea and reached to the sphenoid sinus.
0385-8146/01/$ - see front matter © 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 3 8 5 - 8 1 4 6 ( 0 1 ) 0 0 0 9 6 - 7
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S.-i. Kitajiri et al. / Auris Nasus Larynx 28 (2001) 365–367
Fig. 2. Left: horizontal CT demonstrated that the bamboo stick (*, asterisk) stuck into the middle meatus. Right: the bamboo stick penetrated the ethmoid sinus just medial to the lamina papyracea and reached to the sphenoid sinus (arrow: the end of the bamboo stick).
The foreign body was grasped by forceps and pulled out from the nasal cavity on the day of his first visit. The extracted bamboo stick was about 8 cm in length (Fig. 3). There was some resistant when it was removed, but nasal bleeding was mild and controlled by a tampon soaked with epinephrine and lidocaine. Endoscopic examination of the nasal cavity and paranasal sinuses confirmed no residual foreign bodies and no orbit or skull base injuries. The ethmoid and sphenoid sinuses were widely opened by the stuck bamboo. An ointment-soaked tampon was applied to the wound and removed the next day. His postoperative course has been uneventful for 9 months without wound infection. There is no adhesion or cyst formation in the right ethmoid and sphenoid sinuses open to the middle meatus.
3. Discussion Although foreign bodies in the ethmoid and sphenoid sinuses are rare, bullets [1,2] and metals [3,4] penetrate
the paranasal sinuses through the medial canthus [1]. Long and hard objects, such as wooden sticks [5,6] and ball-point pen [7], have also been reported as foreign bodies in the ethmoid and sphenoid sinuses going through the orbit. However, we found only 11 cases of transnasal foreign bodies in the literature; wooden sticks [5,8], cues [9,10], weed [11], gardening prop [12], pencils [13–15], paint-brush [16] and chopsticks [17]. This is the first report of bamboo stick as transnasal foreign body lodged in the sphenoid sinus. Intracranial injuries were noted in all the above 11 cases. Our case was also noteworthy because of the absence of intracranial complications. Early complications of intracranial injuries due to foreign bodies penetrating through the paranasal sinuses include cerebral, subdural and subarachnoid hemorrhage, CSF leakage and pneumocephalus. Serious infections such as meningitis and cerebral abscess may occur as late complications [11]. However, most penetrating intracranial injuries present with no or mild neurological symptoms just after the onset [12]. Intracranial injuries can be overlooked, especially in cases of transnasal penetrating foreign bodies, because the wound is located in the nasal cavity and is not seen directly [5,9]. In a case report [11], a quick consciousness loss developed due to cerebral hemorrhage after foreign body removal. Penetrating intracranial foreign bodies should be removed under direct vision with craniotomy to minimize cerebral hemorrhage and secure the complete removal of foreign bodies [8,11]. CT examination should be performed before surgery to evaluate the spatial relationship between foreign bodies and surrounding organs, and the severity of tissue damage [5,8,9,11,12]. In the present case, the foreign body was extracted from the nasal cavity because CT showed no evidence of intracranial involvement. However, organic foreign bodies such as wooden sticks are often undetectable by CT. MRI is required in such cases [11]. Although bamboo had a similar signal density to soft tissue on CT, the cylindrical structure containing air spaces facilitated the easy identification of the foreign body. It has been reported that endoscopy was useful for detecting and removing foreign bodies lodged in the nasal cavity and paranasal sinuses [4,6,7]. We also used an endoscope while removing the foreign body. The endoscope was useful for evaluating possible injuries in the orbit and skull base and confirming the absence of residual foreign bodies.
References Fig. 3. The extracted bamboo stick with a diameter of about 1 cm was about 8 cm in length.
[1] Shirai Y, Kachi K, Kano Y. A case of a bullet lodged in the sphenoidal sinus. Practica Otologica 1998;91:161 – 4.
S.-i. Kitajiri et al. / Auris Nasus Larynx 28 (2001) 365–367 [2] Walter DH, Arbor A. Large sphenoid sinus foreign body. Arch Otolaryng 1968;88:436 –8. [3] Dimitriou C, Karavelis A, Triaridis K, et al. Foreign body in the sphenoid sinus. J Craniomaxillofac Surg 1992;20:228 –9. [4] Mladina R. Endoscopic sinus surgery: a metallic foreign body at the sphenoethmoidal junction. J Laryngol Otol 1992;106:998 – 9. [5] Fallon MJ, Plante DM, Brown LW. Wooden transnasal intracranial penetration: an unusual presebtation. J Emerg Med 1992;10:439 – 43. [6] Mori S, Fujieda S, Tanaka T, et al. Numerous transorbital wooden foreign bodies in the sphenoid sinus. ORL 1999;61:165 – 8. [7] LaFrentz JR, Mair EA, Casler JD. Craniofacial ballpoint pen injury: endoscopic management. Ann Otol Rhinol Laryngol 2000;109:119 – 22. [8] Fujimoto S, Onuma T, Amagasa M, et al. Three cases of intracranial wooden foreign body. No Shinkei Geka 1987;15:751 – 6. [9] Rawlinson JN, Chir B, Russell T, Coakham HB, et al. Transnasal hypophysectomy — an unsusal sporting injury. Surg Neurol 1988;30:311 – 5.
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[10] Healy J. Computed tomography of a cranial wooden foreign body. J Comput Assist Tomogr 1980;4:555 – 6. [11] Nakayama Y, Tanaka A, Arita T, et al. Penetrating head injury caused by weed. No To Shinkei 1995;47:1192 – 4. [12] Nishihara T, Mizunari T, Tanaka S, et al. A case of transsphenoidal penetrating skull base injury by gerdening prop. Jpn J Neurosurg 1995;4:311 – 3. [13] Key S, McCrummen T. Foreign body in the brain. J Am Med Assoc 1932;99:152. [14] Davis E. Two specimens: abscess in the frontal lobe of brain: sinus suppuration. Proc R Soc Med 1934;27:1285 – 8. [15] Stadler H, Manders K, Marks J, et al. Recurrent brain abscess due to unusual foreign body — a case report. J Indiana St Med Assoc 1973;65:799 – 802. [16] deTribolet N, Guignard G, Zander E. Brain abscess after transnasal intracranial penetration of a paint-brush. Surg Neurol 1975;11:187 – 9. [17] Yamamoto I, Yamada S, Sato O. Unusual craniocerebral penetrating injury by a chopstick. Surg Neurol 1985;23:396 –8.
Transnasal bamboo foreign body lodged in the sphenoid sinus Shin-ichiro Kitajiri *, Keisaku Tabuchi, Harukazu Hiraumi Department of Otolaryngology, Toyooka Hospital, 6 -35 Tachino-cho, Toyooka City, Hyogo 668 -8501, Japan Received 5 January 2001; received in revised form 3 March 2001; accepted 23 March 2001
Abstract Transnasal sphenoid sinus foreign body is a rare condition. We report a very rare case of transnasal bamboo foreign body lodged in the sphenoid sinus without damages to the orbital wall or skull base. A 69-year-old man fell down onto a bamboo stick, which snapped after penetrating his face through the right nostril. CT demonstrated that the bamboo stick stuck into the middle meatus, penetrated the ethmoid sinus just medial to the lamina papyracea and reached to the sphenoid sinus. No abnormal findings were detected in the orbit or skull base. The foreign body was removed from the nasal cavity without any complication. The endoscope was useful for evaluating possible injuries in the orbit and skull base and confirming the absence of residual foreign bodies. © 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Sphenoid sinus; Foreign body; Transnasal; Endoscope
1. Introduction Foreign bodies lodge in the ethmoid and sphenoid sinuses mostly through the medial canthus [1]. Transnasal sphenoid sinus foreign body is a rare condition with only 11 cases reported in the literature. In all these cases, intracranial injuries were associated. We report a very rare case of transnasal bamboo foreign body lodged in the sphenoid sinus without damages to the orbital wall or skull base.
and other cranial nerve symptoms were not noted. CT demonstrated that the bamboo stick, cylindrical structure containing air spaces, stuck into the middle meatus, penetrated the ethmoid sinus just medial to the lamina papyracea and reached to the sphenoid sinus. No abnormal findings were detected in the orbit or skull base (Figs. 1 and 2).
2. Case report While picking edible wild plants, a 69-year-old man fell down onto a bamboo stick, which snapped after penetrating his face through the right nostril. He was transferred to the Emergency Department of our hospital. Although nasal bleeding had stopped on his arrival, the bamboo stick with a diameter of about 1 cm was lodged in the middle meatus of the right nose. The outer tip of the stick was located posterior to the nasal vestibule. Visual disturbance, double vision, headache * Corresponding author. Tel.: + 81-796-226111; fax: + 81-796240596. E-mail address: [email protected] (S. Kitajiri).
Fig. 1. Coronal CT demonstrated that the bamboo stick (*, asterisk) stuck into the middle meatus, penetrated the ethmoid sinus, just medial to the lamina papyracea and reached to the sphenoid sinus.
0385-8146/01/$ - see front matter © 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 3 8 5 - 8 1 4 6 ( 0 1 ) 0 0 0 9 6 - 7
366
S.-i. Kitajiri et al. / Auris Nasus Larynx 28 (2001) 365–367
Fig. 2. Left: horizontal CT demonstrated that the bamboo stick (*, asterisk) stuck into the middle meatus. Right: the bamboo stick penetrated the ethmoid sinus just medial to the lamina papyracea and reached to the sphenoid sinus (arrow: the end of the bamboo stick).
The foreign body was grasped by forceps and pulled out from the nasal cavity on the day of his first visit. The extracted bamboo stick was about 8 cm in length (Fig. 3). There was some resistant when it was removed, but nasal bleeding was mild and controlled by a tampon soaked with epinephrine and lidocaine. Endoscopic examination of the nasal cavity and paranasal sinuses confirmed no residual foreign bodies and no orbit or skull base injuries. The ethmoid and sphenoid sinuses were widely opened by the stuck bamboo. An ointment-soaked tampon was applied to the wound and removed the next day. His postoperative course has been uneventful for 9 months without wound infection. There is no adhesion or cyst formation in the right ethmoid and sphenoid sinuses open to the middle meatus.
3. Discussion Although foreign bodies in the ethmoid and sphenoid sinuses are rare, bullets [1,2] and metals [3,4] penetrate
the paranasal sinuses through the medial canthus [1]. Long and hard objects, such as wooden sticks [5,6] and ball-point pen [7], have also been reported as foreign bodies in the ethmoid and sphenoid sinuses going through the orbit. However, we found only 11 cases of transnasal foreign bodies in the literature; wooden sticks [5,8], cues [9,10], weed [11], gardening prop [12], pencils [13–15], paint-brush [16] and chopsticks [17]. This is the first report of bamboo stick as transnasal foreign body lodged in the sphenoid sinus. Intracranial injuries were noted in all the above 11 cases. Our case was also noteworthy because of the absence of intracranial complications. Early complications of intracranial injuries due to foreign bodies penetrating through the paranasal sinuses include cerebral, subdural and subarachnoid hemorrhage, CSF leakage and pneumocephalus. Serious infections such as meningitis and cerebral abscess may occur as late complications [11]. However, most penetrating intracranial injuries present with no or mild neurological symptoms just after the onset [12]. Intracranial injuries can be overlooked, especially in cases of transnasal penetrating foreign bodies, because the wound is located in the nasal cavity and is not seen directly [5,9]. In a case report [11], a quick consciousness loss developed due to cerebral hemorrhage after foreign body removal. Penetrating intracranial foreign bodies should be removed under direct vision with craniotomy to minimize cerebral hemorrhage and secure the complete removal of foreign bodies [8,11]. CT examination should be performed before surgery to evaluate the spatial relationship between foreign bodies and surrounding organs, and the severity of tissue damage [5,8,9,11,12]. In the present case, the foreign body was extracted from the nasal cavity because CT showed no evidence of intracranial involvement. However, organic foreign bodies such as wooden sticks are often undetectable by CT. MRI is required in such cases [11]. Although bamboo had a similar signal density to soft tissue on CT, the cylindrical structure containing air spaces facilitated the easy identification of the foreign body. It has been reported that endoscopy was useful for detecting and removing foreign bodies lodged in the nasal cavity and paranasal sinuses [4,6,7]. We also used an endoscope while removing the foreign body. The endoscope was useful for evaluating possible injuries in the orbit and skull base and confirming the absence of residual foreign bodies.
References Fig. 3. The extracted bamboo stick with a diameter of about 1 cm was about 8 cm in length.
[1] Shirai Y, Kachi K, Kano Y. A case of a bullet lodged in the sphenoidal sinus. Practica Otologica 1998;91:161 – 4.
S.-i. Kitajiri et al. / Auris Nasus Larynx 28 (2001) 365–367 [2] Walter DH, Arbor A. Large sphenoid sinus foreign body. Arch Otolaryng 1968;88:436 –8. [3] Dimitriou C, Karavelis A, Triaridis K, et al. Foreign body in the sphenoid sinus. J Craniomaxillofac Surg 1992;20:228 –9. [4] Mladina R. Endoscopic sinus surgery: a metallic foreign body at the sphenoethmoidal junction. J Laryngol Otol 1992;106:998 – 9. [5] Fallon MJ, Plante DM, Brown LW. Wooden transnasal intracranial penetration: an unusual presebtation. J Emerg Med 1992;10:439 – 43. [6] Mori S, Fujieda S, Tanaka T, et al. Numerous transorbital wooden foreign bodies in the sphenoid sinus. ORL 1999;61:165 – 8. [7] LaFrentz JR, Mair EA, Casler JD. Craniofacial ballpoint pen injury: endoscopic management. Ann Otol Rhinol Laryngol 2000;109:119 – 22. [8] Fujimoto S, Onuma T, Amagasa M, et al. Three cases of intracranial wooden foreign body. No Shinkei Geka 1987;15:751 – 6. [9] Rawlinson JN, Chir B, Russell T, Coakham HB, et al. Transnasal hypophysectomy — an unsusal sporting injury. Surg Neurol 1988;30:311 – 5.
367
[10] Healy J. Computed tomography of a cranial wooden foreign body. J Comput Assist Tomogr 1980;4:555 – 6. [11] Nakayama Y, Tanaka A, Arita T, et al. Penetrating head injury caused by weed. No To Shinkei 1995;47:1192 – 4. [12] Nishihara T, Mizunari T, Tanaka S, et al. A case of transsphenoidal penetrating skull base injury by gerdening prop. Jpn J Neurosurg 1995;4:311 – 3. [13] Key S, McCrummen T. Foreign body in the brain. J Am Med Assoc 1932;99:152. [14] Davis E. Two specimens: abscess in the frontal lobe of brain: sinus suppuration. Proc R Soc Med 1934;27:1285 – 8. [15] Stadler H, Manders K, Marks J, et al. Recurrent brain abscess due to unusual foreign body — a case report. J Indiana St Med Assoc 1973;65:799 – 802. [16] deTribolet N, Guignard G, Zander E. Brain abscess after transnasal intracranial penetration of a paint-brush. Surg Neurol 1975;11:187 – 9. [17] Yamamoto I, Yamada S, Sato O. Unusual craniocerebral penetrating injury by a chopstick. Surg Neurol 1985;23:396 –8.